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Prescription 2015: An Organic Apple a Day

These days, I don’t how many kids are familiar with old adage, “An apple a day keeps the doctor away”. At some point in my own life, I heard it or read it and from that point forward, it was mysteriously ingrained in my psyche. That started me wondering about where it all started. Who said it first and why? According to Caroline Taggart, the author of the 2009 book entitled, “An Apple a Day: Old-Fashioned Proverbs and Why They Still Work”, the phrase originated in Pembrokeshire, Wales in the 1860’s. During that era, the phrasing was a bit different: “Eat an apple on going to bed, and you’ll keep the doctor from earning his bread”. Many years later, I vividly recall attending a presentation by Dr. Julian Whitaker, the famed integrative doctor, in which he proclaimed an apple a day as one of his personal healing traditions. And now, once again, modern science is coming around to offer support for an old fashioned notion.

Some of what is known about apples isn’t exactly breaking news. For quite a long while, scientists have been aware that apples are a good source of health promoting properties, including potassium, soluble fiber (pectin) and Vitamin C. In more recent times, researchers have identified a multitude of antioxidants and phytochemicals in apples that likely contribute to this fruit’s positive reputation. Also, there is currently a greater understanding about the value of apple skin as a significant contributor to disease protection.

The latest batch of studies reveal some intriguing findings about how apples promote wellness. A review in the May 2015 issue of the journal Nutrients explains that the fiber and polyphenols in apples alter gut bacteria in a desirable manner. The authors go so far as to hypothesize that this may be a primary reason why apples have been linked to cardiovascular protection. However, other trials report that the cardiovascular benefits of apple intake may have more to do with improved vascular function due to increased nitric oxide production and meaningful reductions in LDL aka “bad” cholesterol. Another promising area of study has drawn an inverse association between one or more apples daily and colorectal cancer. In one investigation, the level of protection vis-a-vis apples and the incidence of colorectal cancer was a whopping 63%. Of note, in that study, apples were the only fruit that imparted significant risk reduction.

More support for eating a daily apple comes courtesy of the the May 2015 edition of Nutriton Journal. In it, a trial examined the effects of apple consumption on diet quality and obesity in children. The researchers determined that kids who ate whole apples regularly ranked higher on the healthy eating index (HEI) and were 30% less likely to be overweight in comparison to non-apple eaters. The far reaching implications of greater nutrient density cannot be overstated. For instance, a 2014 study discovered that women who ate the most apples reported better sexual function and satisfaction. It’s not known exactly why, but enhanced nutrition and/or phytochemicals in apples may be responsible. Whatever the mechanism, if this finding is replicated in other studies it would surely benefit the lives of many women and their partners.

As healthful as apples can be, there are a few considerations to keep in mind. Conventionally grown apples are heavily treated with pesticides. As I mentioned earlier, many of the beneficial components of apples are found in the skin. Unfortunately, that’s also where you’ll find a high concentration of pesticide residue. Opting for organic apples allows you to lower your exposure to toxic chemicals while still eating the skin. Additionally, I think the healthiest way to enjoy apples is at the end of a meal or as part of snack that includes healthy fat and protein. I love apples for dessert or sometimes have a Fuji or Gala apple with a handful of almonds or walnuts and a cup of green tea as a snack. It’s delicious and helps to ensure a milder glycemic response. What could be better?

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

14 Comments & Updates to “Prescription 2015: An Organic Apple a Day”

Assessing non-digestible compounds in apple cultivars and their potential as modulators of obese faecal microbiota in vitro.

The health benefits of apple bioactive compounds have been extensively reported. However, only few studies have focused on bioactive compounds that are not absorbed and metabolised during gastrointestinal digestion and can induce changes in microbial populations of faeces. We have characterised Braeburn, Fuji, Gala, Golden Delicious, Granny Smith, McIntosh and Red Delicious cultivars and found significant differences for extractable phenolics (1.08-9.2mg/g) non-extractable proanthocyanidins (3.28-5.7mg/g), and dietary fibre (20.6-32.2%) among cultivars with Granny Smith having the highest contents. Granny Smith was used after in vitro digestion for fermentation of faeces from diet-induced obese mice. Results showed that relative abundances of Firmicutes, Bacteroidetes, Enterococcus, Enterobacteriaceae, Escherichia coli, and Bifidobacterium in apple cultured faeces tended to resemble the abundance in faeces from lean mice with increased trend in the production of butyric acid. These results suggest that apple non-digestible compounds might help to re-establish a disturbed microbiota balance in obesity.

Higher dietary anthocyanin and flavonol intakes are associated with anti-inflammatory effects in a population of US adults.

BACKGROUND: Although growing evidence from trials and population-based studies has supported a protective role for flavonoids in relation to risk of certain chronic diseases, the underlying mechanisms remain unclear. Several previous studies focused on individual inflammatory biomarkers, but because of the limited specificity of any individual marker, an assessment of a combination of biomarkers may be more informative.

OBJECTIVE: We used an inflammation score (IS) that integrated 12 individual inflammatory biomarkers for the examination of associations with intakes of different flavonoid classes.

DESIGN: The study was a cross-sectional analysis of 2375 Framingham Heart Study Offspring Cohort participants. Intakes of total flavonoids and their classes (anthocyanins, flavonols, flavanones, flavan-3-ols, polymers, and flavones) were calculated from validated food-frequency questionnaires. Individual inflammatory biomarkers were ranked, standardized, and summed to derive an overall IS and subgroup scores of functionally related biomarkers.

RESULTS: In multivariate analyses, an inverse association between higher anthocyanin and flavonol intakes and IS was observed with a mean ± SE difference between quintile categories 5 and 1 of -1.48 ± 0.32 (P-trend ≤ 0.001) and -0.72 ± 0.33 (P-trend = 0.01), respectively. Results remained significant after additional adjustment for physical activity, and vitamin C and fruit and vegetable intakes. Higher anthocyanin intake was inversely associated with all biomarker subgroups, whereas higher flavonol intake was associated only with lower cytokine and oxidative stress biomarker concentrations. In food-based analyses, higher intakes of apples and pears, red wine, and strawberries were associated with a lower IS with differences between quintiles 5 and 1 of -1.02 ± 0.43 (P = 0.006), -1.73 ± 0.39 (P < 0.001), and -0.44 ± 0.88 (P = 0.02), respectively. Although intakes of other classes were not associated with a reduction in overall IS, higher intakes of flavan-3-ols and their polymers were associated with a significant reduction in oxidative stress biomarkers.

CONCLUSION: These findings provide evidence to suggest that an anti-inflammatory effect may be a key component underlying the reduction in risk of certain chronic diseases associated with higher intakes of anthocyanins and flavonols. The Framingham Offspring Study was registered at clinicaltrials.gov as NCT00005121 (Framingham Heart Study).

BACKGROUND: The health-promoting properties of apples are directly related to the biologically active compounds that they contain, such as polyphenols. The objective of this study was to prepare a low-sugar, fibre- and phlorizin-enriched powder from unripe apples and to gain insight regarding its anti-hyperglycaemic activity in healthy volunteers.

RESULTS: The unripe apples (Malus domestica Borkh.) were collected 30 days after the full bloom day; blanched and pressed to obtain apple pomace which was then processed with a food cutter, oven-dried and milled to prepare apple powder. The concentrations of total sugars, water-soluble pectin and phlorizin in the apple preparation were 153.44 ± 2.46, 27.73 ± 0.51 and 12.61 ± 0.15 g kg(-1), respectively. Acute ingestion of the apple preparation improved glucose metabolism in the oral glucose tolerance test (OGTT) in six healthy volunteers by reducing the postprandial glucose response at 15 to 30 min by approximately two-fold (P < 0.05) and by increasing urinary glucose excretion during the 2- to 4-h interval of the OGTT by five-fold (P < 0.05).

CONCLUSION: The results obtained indicate that the dried and powdered pomace of unripe apples can be used as a health-promoting natural product for the reduction of postprandial glycaemia and to improve the health of patients with diabetes.

Improvement of Endurance Based on Muscle Fiber-Type Composition by Treatment with Dietary Apple Polyphenols in Rats.

A recent study demonstrated a positive effect of apple polyphenol (APP) intake on muscle endurance of young-adult animals. While an enhancement of lipid metabolism may be responsible, in part, for the improvement, the contributing mechanisms still need clarification. Here we show that an 8-week intake of 5% (w/w) APP in the diet, up-regulates two features related to fiber type: the ratio of myosin heavy chain (MyHC) type IIx/IIb and myoglobin protein expression in plantaris muscle of 9-week-old male Fischer F344 rats compared to pair-fed controls (P < 0.05). Results were demonstrated by our SDS-PAGE system specialized for MyHC isoform separation and western blotting of whole muscles. Animal-growth profiles (food intake, body-weight gain, and internal-organ weights) did not differ between the control and 5% APP-fed animals (n = 9/group). Findings may account for the increase in fatigue resistance of lower hind limb muscles, as evidenced by a slower decline in the maximum isometric planter-flexion torque generated by a 100-s train of electrical stimulation of the tibial nerve. Additionally, the fatigue resistance was lower after 8 weeks of a 0.5% APP diet than after 5% APP, supporting an APP-dose dependency of the shift in fiber-type composition. Therefore, the present study highlights a promising contribution of dietary APP intake to increasing endurance based on fiber-type composition in rat muscle. Results may help in developing a novel strategy for application in animal sciences, and human sports and age-related health sciences.

Although the incidence of colorectal cancer (CRC) has been declining in recent decades, it remains a major public health issue as a leading cause of cancer mortality and morbidity worldwide. Prevention is one milestone for this disease. Extensive study has demonstrated that a diet containing fruits, vegetables, and spices has the potential to prevent CRC. The specific constituents in the dietary foods which are responsible for preventing CRC and the possible mechanisms have also been investigated extensively. Various phytochemicals have been identified in fruits, vegetables, and spices which exhibit chemopreventive potential. In this review article, chemopreventive effects of phytochemicals including curcumin, polysaccharides (apple polysaccharides and mushroom glucans), saponins (Paris saponins, ginsenosides and soy saponins), resveratrol, and quercetin on CRC and the mechanisms are discussed. This review proposes the need for more clinical evidence for the effects of phytochemicals against CRC in large trials. The conclusion of the review is that these phytochemicals might be therapeutic candidates in the campaign against CRC.

The aim of this study was to evaluate the health benefits associated with apple consumption following cadmium exposure. A total of 15 Wistar rats were distributed into three groups (n=5), as follows: control group (non-treated group, CTRL); cadmium group (Cd) and apple juice group (Cd+AJ). The results showed a decrease in the frequency micronucleated cells in bone marrow and hepatocytes in the group exposed to cadmium and treated with apple juice. Apple juice was also able to reduce the 8OHdG levels and to decrease genetic damage in liver and peripheral blood cells. Catalase (CAT) was decreased following apple juice intake. Taken together, our results demonstrate that apple juice seems to be able to prevent genotoxicity and oxidative stress induced by cadmium exposure in multiple organs of Wistar rats.

Apple intake is inversely associated with all-cause and disease-specific mortality in elderly women.

Higher fruit intake is associated with lower risk of all-cause and disease-specific mortality. However, data on individual fruits are limited, and the generalisability of these findings to the elderly remains uncertain. The objective of this study was to examine the association of apple intake with all-cause and disease-specific mortality over 15 years in a cohort of women aged over 70 years. Secondary analyses explored relationships of other fruits with mortality outcomes. Usual fruit intake was assessed in 1456 women using a FFQ. Incidence of all-cause and disease-specific mortality over 15 years was determined through the Western Australian Hospital Morbidity Data system. Cox regression was used to determine the hazard ratios (HR) for mortality. During 15 years of follow-up, 607 (41·7 %) women died from any cause. In the multivariable-adjusted analysis, the HR for all-cause mortality was 0·89 (95 % CI 0·81, 0·97) per sd (53 g/d) increase in apple intake, HR 0·80 (95 % CI 0·65, 0·98) for consumption of 5-100 g/d and HR 0·65 (95 % CI 0·48, 0·89) for consumption of >100 g/d (an apple a day), compared with apple intake of <5 g/d (P for trend=0·03). Our analysis also found that higher apple intake was associated with lower risk for cancer mortality, and that higher total fruit and banana intakes were associated lower risk of CVD mortality (P<0·05). Our results support the view that regular apple consumption may contribute to lower risk of mortality.

Annurca (Malus pumila Miller cv. Annurca) apple as a functional food for the contribution to a healthy balance of plasma cholesterol levels: results of a randomized clinical trial.

BACKGROUND: Recent human studies have evaluated the effect of daily apple consumption on plasma cholesterol level, which is recognized as an important risk factor for cardiovascular disease (CVD). Nevertheless, slightly significant effects have been generally registered although consuming more than two apples a day for several weeks.

RESULTS: This study describes the influence of daily consumption of Annurca apples on the cholesterol levels of mildly hypercholesterolaemic healthy subjects. A monocentric, randomized, parallel-group, placebo-controlled, 4-month study was conducted. The subjects (n = 250) were randomly assigned to five treatment groups (each one of 50 subjects: 28 men and 22 women). Four groups were administered one apple per day among the following: Red Delicious, Granny Smith, Fuji, Golden Delicious. The fifth group was asked to consume two Annurca apples per day, since the weight of this cultivar is on average half that of the commercial ones considered in this study. Comparing results, Annurca led to the most significant outcome, allowing a reduction in total and low-density lipoprotein cholesterol levels by 8.3% and 14.5%, respectively, and an increase in high-density lipoprotein cholesterol levels by 15.2% (all P < 0.001).

CONCLUSION: Our data would reasonably indicate Annurca apple as a useful tool to contribute to the prevention of CVD risk through normal diet.

A Healthy Balance of Plasma Cholesterol by a Novel Annurca Apple-Based Nutraceutical Formulation: Results of a Randomized Trial.

Cardiovascular diseases are nowadays preferential targets of preventive medicine through a straightforward therapy on lipid profile. However, statins, the first-line lipid-lowering drug therapy, specifically act on low-density lipoprotein cholesterol (LDL-C), having a modest effect on plasma high-density lipoprotein cholesterol (HDL-C) concentrations. Today, a number of novel HDL-targeted therapies are emerging, along with unexpected side effects. Thus, novel and possibly safe substances, able to correct impaired lipid profile in humans, are still in great demand. Herein, based on encouraging clinical data, we formulated a nutraceutical product (AppleMetS®, AMS), based on a polyphenolic extract from Annurca apple, and demonstrated that two capsules a day of AMS, after one month, have a LDL-C lowering outcome equivalent to 40 mg of simvastatin or 10 mg of atorvastatin. Nevertheless, different from statin-based therapy, AMS exerted a notable effect on HDL (+49.2%). Based on the trial results, we can assert that AMS formulation could effectively integrate the current therapeutic arsenal to correct impaired lipid profile in humans. Specifically, AMS may be considered a complementary and/or alternative safe substance suitable for the treatment of mildly hypercholesterolemic subjects who do not present occurrence of atheromatous plaques yet.

SCOPE: The cardioprotective effects of apples are primarily attributed to flavonoids, found predominantly in the skin. This study aimed to determine if acute and/or chronic (4 weeks) ingestion of flavonoid-rich apples improves endothelial function, blood pressure (BP) and arterial stiffness in individuals at risk for CVD.

Effect of chewing an apple on dental plaque removal and on salivary bacterial viability.

OBJECTIVES: Studies on dental plaque removal by chewing an apple are scarce and dated, with conflicting findings. This study aimed to determine whether chewing an apple produced mechanical removal of dental plaque or had any effect on salivary bacterial viability.

METHODS: The study group consisted of 20 healthy adults with good oral health status who were randomly assigned to brush their teeth or eat an apple. After 2 weeks, the experiment was repeated with the order reversed. Plaque index (PI) and the bacterial viability (BV) in a sample of whole saliva (spit) were determined before brushing or apple eating (baseline, B), immediately afterward (A) and 24 hours afterward (24).

RESULTS: After chewing an apple, PI-A was significantly higher than both PI-B (P < .001) and PI-24 (P < .001). BV-A was significantly lower than BV-B (P < .001), with a return to baseline values at the BV-24 measurement.

CONCLUSIONS: Chewing an apple does not remove dental plaque, and may favor plaque regrowth during the first 24 hours, but it does produce an immediate reduction in salivary bacterial viability similar to that after tooth brushing.

Be well!

JP

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